IntelliRide Standing Order Request Form
The IntelliRide Standing Order Request Form is designed for members to request transportation services. It gathers essential information such as personal details, appointment schedules, and pickup/dropoff instructions to facilitate effective transportation planning.
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How do I fill this out?
To fill out the IntelliRide Standing Order Request Form, start by entering your personal information in the designated sections. Ensure that you provide accurate details regarding your appointments and the transportation provider. Lastly, review the form for completeness before submission.
How to fill out the IntelliRide Standing Order Request Form?
1
Start by filling in your personal details including first name, last name, and date of birth.
2
Provide information about your appointment schedule including start and end dates.
3
Indicate the pickup and dropoff locations along with special instructions.
4
Check if you need an escort or personal care attendant and provide their details if applicable.
5
Review all provided information to ensure accuracy before submitting the form.
Who needs the IntelliRide Standing Order Request Form?
1
Patients requiring regular medical transportation services.
2
Healthcare providers coordinating treatment for patients.
3
Caregivers assisting patients with managing appointments.
4
Insurance agents needing details about patient transportation for claims.
5
Administrative staff organizing patient transportation schedules.
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What are the instructions for submitting this form?
To submit the IntelliRide Standing Order Request Form, send the completed document via fax to 720-302-0106. Alternatively, you can email the form to us.coclinicalcoordinator@transdev.com. Ensure that you check the submission guidelines specific to your provider to avoid issues.
What are the important dates for this form in 2024 and 2025?
Important dates for the use of this form include annual renewal periods for transportation services and any special submission deadlines for healthcare plan updates. Ensure all required submissions align with appointment dates for uninterrupted service.
What is the purpose of this form?
The purpose of the IntelliRide Standing Order Request Form is to facilitate efficient transportation for patients who require regular medical appointments. This comprehensive document collects crucial information such as patient details, appointment schedules, and specific transportation needs. By using this form, users can ensure that they receive appropriate transport services tailored to their medical requirements.
Tell me about this form and its components and fields line-by-line.
- 1. First Name: The legal first name of the patient.
- 2. Last Name: The legal last name of the patient.
- 3. Date of Birth: The patient's date of birth for identification.
- 4. Health First Colorado ID: Identification number associated with the patient's Health First Colorado membership.
- 5. Phone Number: The primary contact number for the patient.
- 6. Email: Available email address for communication.
- 7. Reason for standing order: The medical reason for requesting transportation.
- 8. Pickup Information: Details regarding where the patient will be picked up.
- 9. Dropoff Information: Details about where the patient will be dropped off after the appointment.
- 10. Appointment Schedule: The days and times when the patient requires transportation.
What happens if I fail to submit this form?
If you fail to submit the IntelliRide Standing Order Request Form, you may face delays in receiving necessary transportation services. This can lead to missed appointments and hinder your access to medical care. It is crucial to ensure timely submission to maintain your scheduled services.
- Transportation Delays: Without timely submission, your request for transport may not be processed in time.
- Missed Appointments: Failure to submit the form could lead to missed medical appointments.
- Insurance Issues: Lack of an official request may result in complications with insurance claims.
How do I know when to use this form?
- 1. Routine Medical Appointments: Use this form for scheduling regular visits to healthcare providers.
- 2. Specialized Treatment Sessions: Employ it when needing transport for specific medical treatments like dialysis.
- 3. Accompanied Transport Needs: Necessary when you require an escort for assistance during transport.
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